What’s the Lowest successful Methotrexate dose

Caleb1981

I had an appointment with my Rheumy nurse today and she was lecturing me on my low starting dose and slow rate of increasing my dose.

I’m interested to see what the lowest dose that people have found to work for them?

stickywicket

As I dimly recall, I was started on 10mgs, soon went up to 22.5mgs, gradually got it down to 15mgs where I stayed for years (alongside hydroxychloroquine) and have been jogging along on 10mgs for some years now. Less than that and my inflammatory levels still go up even if I feel OK. Even on 10mgs my rheumatoid nodules are growing impressively and I suspect my rheumatologist would want some input on that if our appointments hadn't all been by phone for two years. (Maybe I should 'fess up next time.)

I think the idea, with RA and, indeed, many other diseases, is to clobber it good and hard asap and then, when you have some control, see how far you can ease up. A bit like you or I facing Tyson Fury. We'd need the odds evening up i n our favour before we start.

Caleb1981

I’m starting on 2.5mg and working my way up to the prescribed 10. I’m hoping that the slow introduction will reduce some of the side effects 🤞🏻.

Arthuritis

@stickywicket Those nodules are like fast growing mushrooms that seem to sudden pop almost overnight! Because they seem to bony (guessing) they don’t even go down once there. So annoying

frogmorton

I do understand @Caleb1981 not everyone experiences the side effects I hope you are one of the lucky ones🤞

Take care

Toni x

Arthuritis

@Caleb1981 I think I mentioned elsewhere how low dose can be ineffectual, I was on 5mg, then 15mg and it took 2 months for any noticeable benefit. The problem with cartilage & joint damage is its not linear, you can go painfree while getting wrecked for a long time until your reserves are nearly gone, then all hell breaks lose, or it did in my case. I wish I’d followed my rheumy’s EXPERIENCED & concerned urgency, and asked to adjust the dose IF I had any adverse reaction, which I did not, and the frequent blood tests check for this. Things you might also want to get tested for is any past persistent viral infections that might get reactivated. The most notorious in the UK is Hep-B, as unlike the USA, kids are not routinely vaccinated for this nasty. The rheumy won’t test you for this unless you ask. Depending on your rotator location you might have already been tested/vax’d for this.

I hope it works out well for you.

Caleb1981

Thanks @Arthuritis

There’s a huge part of me wishes I’d bitten the bullet years ago but I just wasn’t there mentally - unfortunately not really any support for that kind of stuff.

My rheumatologist had me tested in November for past viruses - all good 👍.

No where exotic for offshore life, I work in the North Sea 🤣.